Even After Stopping HRT, Risks Linger

March 4, 2008

By LINDSEY TANNERAP Medical Writer

CHICAGO (AP) - The first follow-up of a landmark study of
hormone use after menopause shows heart problems linked with the
pills seem to fade after women stop taking them, while surprising
new cancer risks appear.

That heart trouble associated with hormones may not be permanent
is good news for millions of women who quit taking them after the
government study was halted six years ago because of heart risks
and breast cancer.

But the new risks for other cancers, particularly lung tumors,
in women who'd taken estrogen-progestin pills for about five years
puzzled the researchers and outside experts.

Those risks "were completely unanticipated," said Dr. Gerardo
Heiss of the University of North Carolina in Chapel Hill, lead
author of the follow-up analysis.

The analysis focused on participants' health in the first two to
three years after the study's end. During that time, those who'd
taken hormones but stopped were 24 percent more likely to develop
any kind of cancer than women who'd taken dummy pills during the
study.

"There's still a lot of uncertainty about the cause of the
increased cancer risk," said analysis co-author Dr. JoAnn Manson,
chief of preventive medicine at Harvard's Brigham and Women's
Hospital.

The cancers included breast tumors, which also occurred more
frequently in hormone users during the study.

The researchers noted that the increased risks for all cancers
amounted to only three extra cases per year for every 1,000 women
on hormone pills, compared with nonusers.

Still, Heiss said the results suggest that former hormone users
need to be vigilant about getting cancer screening including
mammograms.

"Vigilance is justified," he said. "No alarm, but
vigilance."

The initial study of 16,608 postmenopausal women was designed to
examine pros and cons of taking pills long thought to benefit
women's health. It was halted in 2002 when more breast cancers,
heart attacks and related problems were found in hormone users
versus nonusers.

There were some health benefits - decreased risks for hip
fractures and colorectal cancer - but the follow-up found those
also faded after women stopped the pills.

Some data suggest that U.S. breast cancer rates have declined
since the study's end. But that likely reflects fewer women
starting on the pills rather than any decline in breast cancer risk
among past users, said Dr. Michael Lauer of the National Heart,
Lung and Blood Institute at the National Institutes of Health,
which conducted and funded the landmark research.

The authors said the new results send the same message they've
been advocating ever since the study ended: Health risks from
estrogen-progestin pills outweigh their benefits, and they should
only be used to relieve hot flashes and other menopause symptoms,
in the lowest possible dose for the shortest possible duration.

The new analysis appears in Wednesday's Journal of the American
Medical Association.

A spokesman for Wyeth Pharmaceuticals, maker of the Prempro
estrogen-protestin pills used in the study, voiced a criticism
frequently cited by scientists, too - that participants were in
their 60s on average, at least 10 years old than typical hormone
users. The latest results thus may not apply to typical users
because older women have different health risks than younger ones,
including more cancers in general, said Wyeth's Dr. Joseph Camardo.

Prempro's packaging information already recommends routine
breast exams and mammograms for users, and Camardo said the
follow-up results are "not anything that's particularly new that
should change guidance."

Manson, the co-author, said it's possible the initial study
results prompted hormone-using participants to see their doctors
more often than nonusers after the study ended, which could have
resulted in more cancers detected.

It's also possible hormones either triggered new tumors or
fueled the growth of existing ones, the researchers said.

"Once a tumor gets started, you might think of it as a train is
out of the station and it might be more difficult to stop it,"
Lauer said.

The follow-up involved 15,730 participants tracked through March
2005.

The authors said the decline in heart problems was not
surprising, since harmful effects of hormones on blood vessels
could be expected to fade after women stopped taking the pills.
Also, heart risks during the study were highest soon after women
started taking hormones.

Dr. Sherry Nordstrom, an obstetrician-gynecologist at the
University of Illinois at Chicago, said the lung cancers were a
surprising finding but called hormones "still very appropriate
therapy" for women with bad symptoms.

Study participant Geraldine Boggs, a Washington, D.C. nurse with
three daughters and four granddaughters, said women should pay
attention to the new findings.

"I initially joined the study to make sure that my daughters
and granddaughters had informed choices about taking them when they
got to be my age," said Boggs, 64.

Boggs, in her early 50s when she enrolled, was assigned to take
hormones. Still, she said she developed no health problems during
the study or afterward, other than hot flashes for about a year
after quitting the pills.

Dr. Nieca Goldberg, a New York University women's heart
specialist, said the study underscores that in addition to cancer
screening, women who stop taking hormones need to find other ways
to keep their bones strong, including getting more calcium and
exercise.